January

A woman in Philadelphia was won her medical negligence claim for being given the wrong medicine, after a mistake at her local surgery caused her to go into cardiac arrest.

Jacqueline DiTore attended the Abington Surgical Centre in Pennsylvania on 7 June 2010 for an elective nasal procedure. Before starting the procedure, her surgeon – Dr Warren Zager – asked a nurse to prepare an anaesthetic injection of 1 percent lidocaine to soak some cotton balls soaked in a nasal decongestant (Afrin) to control the bleeding during the procedure.

The nurse poured the nasal decongestant into a bowl in order to soak the cotton balls before preparing the anaesthetic; but a second nurse mistook the contents of the bowl as lidocaine, drew the liquid into a syringe which she then passed to the doctor. Unaware that the syringe contained decongestant, Dr Zager injected the Afrin into Jacqueline´s nose, and then started to prepare for the surgery.

An anaesthetist present in the operating theatre noticed that Jacqueline´s heart rate had fallen to 36 beats per minute and – unaware that Jacqueline had been injected with enough Afrin to cause a 100-fold increase in vasoconstrictive activity (the narrowing of the blood vessels) – administered an anticholinergic which returned Jacqueline´s heart rate to 80 beats per minute.

When Dr Zager returned to begin the procedure, Jacqueline still had a sensation in her nose and the doctor asked for more 1 percent lidocaine. He was told that the surgery only had 2 percent lidocaine and it was then that the mistake with the nasal decongestant was discovered. Dr Zager chose to continue with the procedure regardless, and administered the 2 percent lidocaine into Jacqueline´s nose.

Following the injection of lidocaine, Jacqueline´s heart rate soared to 140 beats per minute and her blood pressure registered 260/150. At that point labetalol (a drug used to lower high blood pressure) was administered which caused Jacqueline´s blood pressure to crash and she went into cardiac arrest. Jacqueline was rushed to nearby Abington Memorial Hospital where she was resuscitated.

It soon became apparent that Jacqueline had suffered brain damage during the cardiac arrest which left her with impaired cognitive abilities, difficulty with her speech and vision, and short-term memory loss. Doctors advised her that her brain injury is likely to deteriorate as she gets older and, after speaking with a solicitor, Jacqueline made a medical negligence claim for being given the wrong medicine.

Both the Abington Surgical Centre and Dr Zager denied that they were liable for Jacqueline´s injury; arguing that Dr Zager was right to continue with the nasal procedure as the anaesthetic administered in the second injection did not compound the effect of the Afrin, and therefore did not contribute to her reaction. It was also claimed that Jacqueline was “high-functioning”, and that her condition was not as serious as she had claimed.

Jacqueline´s medical negligence claim for being given the wrong medicine went to Montgomery County Court in Philadelphia before Judge Thomas M. Del Ricci. After several weeks of testimony and deliberations, the jury returned a verdict in Jacqueline´s favour. The jury considered Dr Zager to be 38.5 percent negligent for Jacqueline´s brain injuries and the Abington Surgical Centre 61.5 percent negligent. They awarded her $5.1 million compensation.